- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $20.89
| Facility | | $14.13 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.30 / $15.85
| Professional | | $8.91 | $12.30 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.23 / $10.23
| Professional | | $10.23 | $10.23 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $28.84 / $31.62
| Professional | | $22.39 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $20.89 / $25.70
| Professional | | $17.38 | $20.89 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $18.20 / $25.70
| Professional | | $7.24 | $18.20 | $25.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $23.99 / $32.36
| Professional | | $19.50 | $23.99 | $32.36 |